Your gum tissue is like a frame that provides form and shape to the top of your tooth. A less than attractive smile results when the integrity of the gum is compromised or the actual gum between your teeth becomes weak. Usually due to poor hygiene (gum disease), you actually begin to lose gum tissue.

Cosmetic dentistry provides many cosmetic solutions such as composite resin bonding, crowns, and veneers to create a great smile. These solutions are usually part of an overall strategy which may involve cosmetic gum surgery. Used to correct a 'gummy smile' (a significant portion of your gum is exposed when you smile), cosmetic gum surgery is the procedure of lengthening your teeth from the neck of the tooth upwards. Your teeth then appear to be longer and much less gum is seen when you smile.

The "Long in the Tooth" Smile - Cosmetic gum surgery, or periodontal plastic surgery, can correct almost any deformity or gingival problems preventing you from a beautiful smile. As we age, our gums may shrink and recede which makes our teeth look longer. While this is often age-related, it can also occur due to a bad bite. A cosmetic dentist or a periodontist can correct this to such an extent, that you'll have a very youthful appearing smile.

The "Gummy Smile" - is a problem where your teeth appear to be too short. Gum sculpting is often the solution. To solve this, a dentist uses a laser to remove the excess tissue of your "gummy" smile, which then exposes more of your tooth.

You should consult your dentist about cosmetic gum surgery if you believe you have "Gummy Smile" (small crown length), gum recession "long teeth", an uneven gum line due to "short teeth", gum loss or gums which appear to be collapsing (from missing teeth), dark or black areas between bridges, implants, crowns or teeth, or tooth sensitivity from receding gums.

There are two primary procedures for cosmetic gum surgery, depending on your current smile.

"Gummy Smile" (Excessive Gingival Display)

• A "Gummy Smile" can occur due to wear of teeth from teeth grinding, a short upper lip, or having a longer than usual upper jawbone. This smile is when your teeth appear too small and your gums appear too large. (Click for the corrective procedure for "Gummy Smile")

To Correct a "Gummy Smile"

• Cosmetic gum surgery can be done to reduce the excess gum and bone. The removal of these tissues allows for normal sized teeth and for a normal gum line appearance by using an instrument, usually a laser, to remove the undesirable tissue. Typically your cosmetic dentist will prescribe an antibacterial mouth rinse to be used twice a day for a two-week period following your surgery.

"Long Tooth Smile" (Gum Recession)

• As your gums recede, your teeth appear longer than normal. While "long teeth" may result in an unattractive smile, you should also be concerned with root sensitivity and possible tooth loss. Recent advances in techniques and materials have resulted in significant improvements in comfort, predictability and esthetics. (Click for the corrective procedure for a "Long Tooth Smile")

To Correct a "Long Tooth Smile"

• As your gums recede, your teeth look much "longer" than normal. Such gum recession exposes your sensitive root surface which often makes hot or cold foods and drinks a painful experience. Teeth can become loose as your gum recedes. The cosmetic gum surgery solution is basically when a cosmetic dentist or periodontist removes tissue from the roof of your mouth and then grafts it onto your gum line. This tissue then reinforces thin gums or fills in areas where your gums have receded. Typically your cosmetic dentist will prescribe an antibacterial mouth rinse to be used twice a day for a two-week period following your surgery.

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The costs involved in cosmetic gum surgery vary extensively based upon how much of your mouth is undergoing a procedure, which corrective procedure is being used, and which other cosmetic dentistry procedures will be needed to provide you with that perfect smile. It is common for other cosmetic dentistry procedures, such as crowns or veneers, to be recommended by your dentist as part of the overall strategy to cosmetically correct your gums. The overall strategy should be extensively discussed with your dentist and well understood by you prior to undergoing these procedures.

Advantages: Healing is usually quick and your more youthful and beautiful smile is obvious early on. It has been reported that cosmetic gum surgery additionally improves the health of your gums. The procedure to correct receding gums may even reduce your tooth sensitivity to cold or hot foods or beverages while protecting your roots from decay and lessening further gum shrinkage.

Disadvantages: Cosmetic gum surgery is of course, surgery. Surgery is often performed in segments under a local anesthetic - unless your entire mouth is undergoing this procedure at once, then a general anesthesia is typically used.

A: "Gum disease" describes a range of conditions that affect the supporting tissues for the teeth. The supporting tissues comprise both the surface tissues that can be seen in the mouth and also the deeper tissues of the bone, root surface and the ligament that connects the teeth to the bone.

A: Periodontal disease is caused by bacteria. Bacteria form a plaque which is a sticky, colourless film that forms on your teeth, particularly around the gum line. Other bacteria thrive deep in the gap between the gum and the tooth (the pocket). Some people are much more at risk of developing periodontal disease smoking is one of the major risk factors. Other conditions such as diabetes, stress, pregnancy and various medications can all be contributing factors.

A: Infection affecting the surface tissues is called Gingivitis. This may progress to affect the deeper supporting tissues and is called Periodontitis (previously called pyorrhea). The effects of gingivitis are largely reversible with appropriate care. Once this has progressed to periodontitis there is permanent damage to the ligament and bone that supports and holds the teeth. Often a space develops between the gum and the tooth called a pocket. The pocket forms a protected environment for more bacteria and the condition progresses. If left untreated periodontitis may cause abscesses and tooth loss.

A: Yes. In the vast majority of cases the progression of gum disease can be arrested with appropriate care. Management of gum disease becomes more difficult and less predictable the more advanced the disease. Therefore, the sooner periodontitis is diagnosed and treated the better. Regular dental examinations are important to check for the presence of gum disease.

The cause of gum disease is bacteria. To manage it, the bacteria must be reduced to a level the body's defense mechanisms can handle. Treatment classically involves:

• achieving the best possible home care
• professional cleaning of the teeth above and below the gum line (into the pockets) to remove the plaque and hard deposits (calculus / tartar),
• regular reviews
• trying to remove risk factors such as smoking.

Gum disease causes permanent damage to the supporting tissues; therefore the aim of treatment is to stop the progression of the disease through controlling the bacteria. This is an ongoing, lifelong activity.

Your general dentist is trained in managing periodontal problems. They may also use a hygienist to assist in your care. You may be referred to a Periodontist if your dentist considers your condition needs more advanced care. A specialist periodontist has gained additional qualifications and experience to satisfy the requirements of the State Dental Board and may therefore use the title "Periodontist".

Prevention is best. To a large extent periodontitis can be prevented by good oral hygiene and early intervention when problems are identified. See your dentist regularly.

A: No. Bleeding gums are common but not OK. In a healthy state gums do not bleed. Bleeding is often an indication that the gums are inflamed. The inflammation is generally a response to the bacteria on the surface of the teeth. The surface inflammation is Gingivitis. The bleeding may also arise from Periodontitis or traumatic cleaning. Bleeding gums are sometimes associated with serious medical conditions.

A: There is no reason why a pregnancy should cause you to lose your teeth unless you ignore them totally.

During pregnancy the gums become more sensitive to bacterial irritation and may show an increased inflammation response. The type of bacteria around the teeth may also change to a type more associated with the cause of periodontitis. It is very important to maintain good oral hygiene and have regular dental checks during pregnancy.

Periodontitis can show a family tendency. So if a mother or father has periodontitis then there is an increased risk for their children to have periodontitis. Regular dental checks for periodontitis are even more important for those at higher risk for periodontitis.

A: Many people will have a small amount of periodontitis, which gradually increases with age. However approximately 15% of the population will have a significant degree of periodontitis. The destruction of the tooth's supporting tissues caused by periodontitis gets worse over time when left untreated, and is often seen more severely in the 45+ age group. However the different types of periodontitis may affect people of all ages.

The risk for periodontitis is increased with poor oral hygiene, smoking, diabetes, a family history of periodontitis and a range of medical conditions, in particular those affecting the immune system.

A: Bleeding gums when you brush your teeth.

A: Visit your dentist, who will examine your gums as part of a normal dental check-up. X-rays are often needed to help diagnose any gum problems.

Good dental hygiene is one of the most important factors in preventing gum disease. Your dentist will show you proper brushing and flossing techniques that will help ensure healthy teeth and gums.

You may need to be referred to a Periodontist who is a specialist in treating gum disease. Treatment involves careful, deep cleaning of the teeth to remove the cause of the problem. This can be done with local anaesthetic.